Contralateral limb biomechanics when offloading

NewsBot · Apr 22, 2018

Members do not see these Ads. Sign Up.
Decreasing an Offloading Device’s Size and Offsetting Its Imposed Limb Length Discrepancy Lead to Improved Comfort and Gait
Ryan T. Crews and Joseph Candela
Diabetes Care 2018 Apr; dc172584. https://doi.org/10.2337/dc17-2584

OBJECTIVE Patient adherence is a challenge in offloading diabetic foot ulcers (DFUs) with removable cast walkers (RCWs). The size and weight of an RCW, changes to gait, and imposed limb length discrepancies may all discourage adherence. This study sought to determine whether RCW size and provision of a contralateral limb lift affected users’ comfort and gait.

RESEARCH DESIGN AND METHODS Twenty-five individuals at risk for DFUs completed several 20-m walking trials under five footwear conditions: bilateral standardized shoes, a knee-high RCW with shoe with or without an external shoe lift contralaterally, and an ankle-high RCW with shoe with or without an external shoe lift contralaterally. Perceived comfort ratings were assessed through the use of visual analog scales. Spatial and temporal parameters of gait were captured by an instrumented walkway, and plantar pressure was measured and recorded using pedobarographic insoles.

RESULTS The bilateral shoes condition was reported to be most comfortable; both RCW conditions without the lift were significantly less comfortable (P < 0.01). In contrast to the ankle-high RCW, the knee-high RCW resulted in significantly slower walking (5.6%; P < 0.01) but greater offloading in multiple forefoot regions of the offloaded foot (6.8–8.1%; P < 0.01). Use of the contralateral shoe lift resulted in significantly less variability in walking velocity (52.8%; P < 0.01) and reduced stance time for the offloaded foot (2.6%; P = 0.01), but it also reduced offloading in multiple forefoot regions of the offloaded foot (3.7–6.0%; P < 0.01).

CONCLUSIONS Improved comfort and gait were associated with the ankle-high RCW and contralateral limb lift. Providing this combination to patients with active DFUs may increase offloading adherence and subsequently improve healing.
Click to expand...

NewsBot · May 20, 2018

Peak Pressure Data and Pressure-Time Integral in the Contralateral Limb in Patients with Diabetes and a Trans-tibial Prosthesis
Jael Borg et al
Gait and Posture; Article in Press

Highlights
•The preservation of the intact limb following trans-tibial amputation is important.
•The intact limb carries more body weight which increases the risk of ulceration.
•PTI provides valuable information on the total load exposure of the intact foot.
•PPP and PTI measurements are vital when using prosthetic devices.
Click to expand...

Background
Clinicians currently rely on observational clinical data pertaining to the biomechanics of the diabetic foot. However, advances in technology can objectively describe this. A thorough understanding of the functional and mechanical consequences following trans-tibial amputations is lacking.

Research Question
Does a trans-tibial prostheses significantly increase peak plantar pressures and pressure time integrals in the intact foot of patients with type-2 diabetes and neuropathy?

Methods
A prospective quantitative matched-subject design was employed. Twenty participants living with diabetes and peripheral sensory neuropathy were recruited. Ten participants presented with a trans-tibial amputation and 10 had intact feet. Participants were matched for gender, age, foot type and BMI. Peak plantar pressure and pressure time integral data were recorded using the Tekscan HR™ pressure mat system, using the two-step gait protocol. The Shapiro-Wilk test was used to determine normality of data. The Independent Samples T-test and the Mann Whitney U test were carried out to reject the null hypothesis.

Results
Although no significant differences (p < 0.05) in mean peak plantar pressures were observed in all the foot masks analysed between the amputee and the control group, a significant difference (p = 0.002) in mean pressure time integrals was recorded with highest pressure time integral (PTI) values under the 2nd-4th metatarsophalangeal joint (MTP joint) for the trans-tibial amputee group.

Significance
Cumulative exposure of both pressure and time can lead to tissue damage. PTI could be considered as an important contributory factor in determining ulcer formation. Elevated PTI under the 2nd – 4th MTP joints sustained in the intact contralateral limb in patients using below knee prosthesis could possibly be due to gait alterations in this population. The preservation of the contralateral limb is of great concern and importance as this might impact patient’s mobility and quality of life.
Click to expand...

NewsBot · Jan 23, 2019

Pressure distribution under the Contralateral Limb in Charcot Arthropathy with different gait speeds
MohamadMotawea et al
The Foot; 17 January 2019

Highlights
•There are many cases of unilateral Charcot foot develops Charcot after sometime in the contralateral foot.
•The contralateral foot of off-loaded Charcot foot is considered to be a good example for the foot under stress and is worthy of full care to decrease such stress.
•This work aims to study the effect of walking speed on the plantar pressure of the contralateral foot of patients with unilateral Charcot neuro-osteoarthropathy offloaded by removable cast walkers under two walking conditions: (1) neglected leg length discrepancy, (2) nullified leg length discrepancy.
•Pressure time integral was significantly decreased beneath the planter aspect of the contralateral foot when leg length discrepancy was nullified together with slowing of gait speed.
Click to expand...

Background
The total contact cast has been recognized as the “gold standard” for treatment of Charcot neuro-osteoarthropathy (CN). However, removable cast walkers (RCWs) become an alternative option especially after resolution of the acute stage. RCWs with an elevated sole construction often induce leg length discrepancy (LLD) that could significantly affects plantar pressure (PP) distribution in diabetic patients with neuropathy.

Aim
To study the additional effect of walking speed on PP abnormalities induced by LLD.

Method
The study included 16 patients with diabetes (59 ± 8.8 years; 8 men and 8 women), with unilateral CN offloaded by RCW. In-shoe PP distribution was measured using F-scan (Tekscan Inc.), whilst patients walked at their normal gait speed (53 ± 4 steps/min), versus short slow steps (24 ± 3/min) under the two walking conditions: (1) neglected LLD, and (2) corrected LLD.

Results
The greatest reduction in PP was seen during reduction of walking speed, with corrected LLD, followed by corrected LLD with normal walking speed, followed by neglected LLD with slowing of walking speed. The highest PP was found when the patient remain on their normal walking speed and LLD was neglected.

Conclusion
The contralateral foot of CN offloaded with RCW, is subjected to high pressure loads beneath the hallux, 1st, 2nd, 3rd, and 5th metatarsal heads. As such, care should be taken not only to avoid minor LLD, but to also advise the patient to practice short slow steps while walking, so that pressure overload on contralateral limb and its possible contribution to the development of bilateral Charcot, could be minimized.
Click to expand...

NewsBot · Sep 5, 2022

Alterations to plantar loading and ankle range of motion of the contralateral foot during assisted walking in patients with Type 2 Diabetes Mellitus
Jose G Anguiano-Hernandez et al
Gait Posture. 2022 Aug 24;

Aims: Patients with diabetic foot ulcers are instructed to be non-weight bearing on the affected limb to promote healing. Therefore, the aim of this study was to investigate the effect of different assistive devices on whole foot plantar loading, peak forefoot force, ankle range of motion, and locomotion speed during gait in patients with Type 2 Diabetes Mellitus.

Methods: Participants walked normally, with crutches, a walker, and a wheeled knee walker (WKW) in randomized order. Force sensitive insoles and 3D motion capture were used to record plantar normal force and ankle kinematics. Force sensitive pads were wrapped around handles of the crutches and walker to measure bodyweight offloaded onto the assistive device. An instrumented WKW was used to measure bodyweight offloaded onto the handlebars and knee cushion.

Results: Locomotion with the WKW produced the lowest whole foot plantar loading and peak forefoot force in the propulsive limb, while also producing the greatest ankle range of motion and locomotion speed amongst assistive devices.

Conclusions: This pre-clinical study found that the WKW could be the preferred assistive device for total unilateral offloading of diabetic foot ulcers as it reduced propulsive limb whole foot and forefoot plantar loading while retaining ankle range of motion and locomotion speed.
Click to expand...

NewsBot · Apr 3, 2023

Using a contralateral shoe lift to reduce gait deterioration during an offloading fast-walk setting in diabetic peripheral neuropathy: A Comparative Feasibility Study
Nikolas Beauchesne et al
Diabetes Res Clin Pract. 2023 Mar 30

Aims: Diabetic peripheral neuropathy (DPN) is a predictor of foot ulcers and leads to sedentary behaviour. This comparative study evaluated gait and feasibility of a 20-minute fast walk, at 40-60% of cardiopulmonary capacity, in individuals with DPN wearing an offloading boot and a contralateral shoe balancer.

Methods: Gait parameters were measured with inertial sensors on 32 individuals (group with DPN [n = 16], group with diabetes but without DPN [n= 9], and a group without diabetes/DPN [n= 7]). Feasibility was assessed by feedback on perceived effort and adverse events. Gait outcomes were compared between groups with or without a shoe balancer using one-way ANOVAs.

Results: The three groups were equivalent in terms of activity level and age and gender except for the body mass index. Both groups with diabetes exhibited minimal decreased gait speed (p>0.005) and the DPN group exhibited increased double-support percentage (+4.6%, p=0.01) while walking with an offloading boot and contralateral shoe balancer. The use of a contralateral shoe balancer reduced gait asymmetry. Lower physical activity level was associated with further gait deterioration in all groups. Few adverse events were reported, and 91% of participants reported that the proposed activity would be feasible daily.

Conclusions: The offloading boot deteriorated gait function, but a contralateral shoe balancer minimized its impact, especially in the context of physical activity in people with diabetes and DPN.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Cavovarus of one foot with planovalgus deformity of the contralateral foot (Wind swept heels)

Ipsilateral and contralateral foot pronation in those with knee osteoarthritis

Limb Length Discrepancy After Total Hip Joint Replacement Surgery Treated With Heel Lifts

Assessment and classification of upper and lower limb pain in athletes

The role of podiatry in the early identification and prevention of lower limb venous disease

Disuse muscle atrophy of the lower limb

Lower limb injuries; vicious circles

Share This Page